Influenza H1N1 virus

The 1918–1920 influenza pandemic, also known as the Great Influenza Epidemic or the Spanish Flu, was a particularly deadly worldwide influenza pandemic brought on by the H1N1 influenza A virus.

The first case was reported when "epidemic influenza," often known as "the grip," first surfaced in Kansas in the United States in the late spring of 1918, followed by early reports from Spain appearing on May 21.

Both locations reported that it was a "three-day fever." In April, cases were also reported in France, Germany, and the United Kingdom.

Patients packed into a flu ward during the Spanish Flu epidemic.

Spanish flu centenary marked by new colourised photos | Daily Mail Online

The Spanish flu unfolded in three devastating waves. The first wave caused typical flu symptoms but limited fatalities.

However, the second wave, hitting in autumn 1918, proved the deadliest, with a mutated virus causing severe respiratory issues and high mortality rates, particularly among young adults.

This wave overwhelmed healthcare systems globally.

The third wave, arriving in winter 1918-1919, was less lethal than the second but more severe than the first, further straining resources and contributing to the pandemic's overall death toll.

Together, these waves killed an estimated 50 million people worldwide.

In total, the three waves of infection had affected over 500 million people worldwide, or close to one-third of the world's population.

After the Black Death bubonic plague of 1346–1353, estimates of mortality range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in human history.

Spanish Flu occured in three pandemic waves: This chart shows weekly combined influenza and pneumonia mortality in the United Kingdom, 1918–1919 

Centers for Disease Control and Prevention.


Give it a name

The origins of the Spanish flu are shrouded in uncertainty, partly due to wartime censorship and misinformation.

During World War I, belligerent countries suppressed unpleasant news to maintain morale, while neutral Spain freely reported on the pandemic. This transparency gave the misleading impression that Spain was the epicenter of the outbreak, leading to the term "Spanish flu."

As the pandemic spread, the illness quickly acquired the incorrect label of "Spanish influenza" outside Spain. Newspapers in countries involved in the war rarely reported on the disease due to censorship, but Spanish media, unconstrained by such restrictions, covered the outbreak extensively.

The Oakland Municipal Auditorium in use as a temporary hospital. The photograph depicts volunteer nurses from the American Red Cross tending influenza sufferers in the Oakland Auditorium, Oakland, California, during the influenza pandemic of 1918.

From the Joseph R. Knowland collection at the Oakland History Room, Oakland Public Library.

...entrenching the erroneous belief that Spain was the origin...

This situation is illustrated by a dispatch from The Times of London dated June 2, 1918, titled "The Spanish Epidemic," where a correspondent in Madrid reported 100,000 cases of "…the unexplained disease...clearly of a gripal character."

Three weeks later, The Times published an article that indirectly referenced "Spanish influenza," and advertisements for "Spanish influenza prevention" began to appear, such as the Formamint tablet ad.

In Russia, the pandemic was colloquially referred to as "Ispánka (the Spanish lady) is in town," further entrenching the erroneous belief that Spain was the origin.

Advertisement in The Times, 28 June 1918 for Formamint tablets to prevent "Spanish influenza"

The Times Archive | The Times & The Sunday Times

H1N1 1918 influenza virus particles (brown), coloured transmission electron micrograph (TEM). These virus particles (virions) have been recreated from the influenza (flu) virus strain that caused the 1918 Spanish flu pandemic. It was reconstructed by scientists at the Center for Disease Control and Prevention (CDC), Atlanta, USA, in 2005.

H1n1 1918 Influenza Virus, Tem Photograph by Cdc - Fine Art America

...the outbreak did not start in Spain...

This misconception persisted because Spain, being a neutral nation, had no need to maintain an appearance of readiness for battle.

Its newspapers freely reported on the epidemic's effects, including the illness of King Alfonso XIII.

The Spanish reports were so detailed and prominent that they overshadowed the outbreak's presence in other countries, which were equally affected but less forthcoming due to wartime propaganda efforts.

In reality, the outbreak did not start in Spain. Historical evidence suggests the flu may have originated elsewhere, with theories pointing to locations such as Kansas in the United States, where the first recorded case on March 4, 1918, involved Albert Gitchell, an army cook at Camp Funston.

Additionally, earlier cases had been identified in January 1918 in Haskell County, Kansas, where local physician Loring Miner alerted the Public Health Reports journal to the unusual severity of the flu.

Alfonso XIII, the King of Spain became gravely ill from Spanish Flu. His illness and subsequent recovery were reported to the world. This gave the misleading impression that Spain was the most affected area and led to the pandemic being dubbed "the Spanish Flu.

https://en.wikipedia.org/wiki/Alfonso_XIII

https://imgur.com/a/alfonso-xiii-con-ugc-rLe4C

...congested living quarters provided ideal environments for the virus...

The pandemic's rapid spread was facilitated by the conditions of the First World War. Military camps, troop movements, and congested living quarters provided ideal environments for the virus to propagate.

The flu quickly infiltrated Europe, spreading from military camps in the United States to battlefields and civilian populations across France, Great Britain, Italy, and Spain, and reaching Wroclaw and Odessa by May 1918.

Victims of the Spanish flu as they lie in beds at a barracks hospital on the campus of Colorado Agricultural College, Fort Collins, Colorado, in 1918,

American Unofficial Collection of World War I Photographs/PhotoQuest/Getty Images

Despite the first wave being relatively mild, with lower mortality rates than the subsequent waves, its impact on global populations and military operations was significant. Almost 900,000 German soldiers were incapacitated, and approximately 75% of British and French forces were affected, severely hampering war efforts.

Thus, while the term "Spanish flu" suggests a misleading origin, the pandemic's true beginnings are complex, shaped by wartime conditions, censorship, and the interconnectedness of a world at war. The Spanish flu remains a profound example of how misinformation and global events can shape historical narratives and public perception.


Catching the flu

Spanish flu presented a range of symptoms, from typical flu-like signs to severe and often fatal conditions.

Initial symptoms resembled those of seasonal influenza: high fever, chills, fatigue, headaches, and muscle aches.

However, many sufferers quickly developed more alarming symptoms, such as a deep, wracking cough, severe sore throat, and a pronounced sense of malaise.

Aden Field Force. Indian troops who died of influenza being carried to the burning ghats. A frequent scene at Sheikh Othman during the influenza epidemic of Oct-Nov, 1918.

Spanish Flu: The Unseen Enemy | Imperial War Museums (iwm.org.uk)

...the virus's aggressive attack on the lungs...

One of the most striking and deadly symptoms was acute respiratory distress. Patients often experienced cyanosis, a bluish discoloration of the skin, especially noticeable on the lips, ears, and extremities, indicating a severe lack of oxygen.

This was caused by the virus's aggressive attack on the lungs, leading to viral pneumonia. Fluid accumulation in the lungs made breathing increasingly difficult, often resulting in suffocation.

A Spanish Flu headline from the El Paso Times on the 9th October 1918. Catching the Spanish flu carried a high fatality risk due to severe respiratory complications, secondary bacterial infections, and hyperactive immune responses, particularly among young adults, leading to millions of deaths worldwide.

1918 Spanish flu epidemic shut down El Paso (elpasotimes.com)

...blood-tinged sputum...

The Spanish flu also led to secondary bacterial infections, such as bacterial pneumonia, which compounded the suffering and mortality rates.

These infections were difficult to treat effectively, given the limited medical knowledge and lack of antibiotics at the time.

Patients with these secondary infections often experienced high fevers, chest pain, and a productive cough with blood-tinged sputum.

Neurological symptoms were also reported, including delirium and, in some cases, encephalitis (brain inflammation), which could lead to long-term cognitive impairments.

The severe systemic inflammation caused by the flu strained the cardiovascular system, sometimes leading to heart failure.

A quote from Pale Rider by Laura Spinney, which eloquently describes some of the effects of Spanish Flu.

Pale Rider - Google Books

The high mortality rate among young adults, rather than the very young or elderly, was a peculiar aspect of this pandemic. This demographic often suffered from a hyperactive immune response, known as a cytokine storm, which led to severe lung damage and contributed significantly to the high death toll.

Overall, the Spanish flu's symptoms and medical effects were devastating, overwhelming healthcare systems and leaving lasting impacts on global health.


The First Wave 

The origins of the Spanish flu pandemic remain a subject of debate among historians and epidemiologists due to conflicting theories and a lack of conclusive historical evidence.

Despite earlier cases, the pandemic is traditionally marked as beginning on March 4, 1918, with the documented case of Albert Gitchell, an army cook at Camp Funston in Kansas, United States.

However, the illness had already been identified in January 1918, about 200 miles away in Haskell County.

Local physician Loring Miner recognized the unusual severity of the flu and alerted the editors of the Public Health Reports journal of the U.S. Public Health Service, indicating an early awareness of the outbreak's potential gravity.

...its swift transmission capabilities...

Following Gitchell's case, 522 soldiers at Camp Funston reported illness in the subsequent days, showcasing the flu's rapid spread within close quarters.

By March 11, 1918, the virus had reached Queens, New York, evidencing its swift transmission capabilities.

The outbreak was exacerbated by World War I conditions, as Camp Funston was a key training site for American Expeditionary Forces.

The movement of troops and the congested environments of military camps facilitated the virus's dissemination not only across the United States but also to Europe.

St. Louis Red Cross Motor Corps personnel wear masks as they hold stretchers next to ambulances in preparation for victims of the 1918 influenza epidemic.

Library of Congress via AP

The flu quickly infiltrated Europe, spreading to France, Great Britain, Italy, and Spain, reaching Wroclaw and Odessa by May 1918.

The Treaty of Brest-Litovsk in March 1918 further contributed to the spread as Germany released Russian prisoners of war, who then carried the virus back to their home country.

The interconnectedness of the war efforts and the extensive movement of people played a crucial role in the pandemic's global reach.

The first wave of the Spanish flu, although highly contagious, was relatively mild in terms of severity and mortality compared to later waves.

In the United States, 75,000 flu-related deaths were reported in the first half of 1918, a slight increase from the 63,000 deaths during the same period in 1915.

This indicates that while the virus was widespread, the death rates were not alarmingly higher than the average for that time.

Similarly, Madrid, Spain, reported fewer than 1,000 influenza-related deaths during May and June 1918.

A scientific graph from the 1918 ‘Spanish’ flu pandemic showing mortality rates in the US and Europe.

Public Domain

The mild nature of the first wave is further evidenced by the lack of major public health responses.

There were no reported quarantines during the first three months of 1918, reflecting a general underestimation of the potential severity of the outbreak.

However, the flu's impact on military operations during World War I was significant. The illness incapacitated almost 900,000 German soldiers, and approximately 75% of the British and French forces were affected, severely hampering military efforts.

Black and white poster of a Red Cross nurse with a gauze mask over her nose and mouth. Text next to the image provides public health information "To prevent influenza!" Photograph by Paul Thompson (1878 - 1940).

Published in New Haven, Conn. : Illustrated Current News, 1918.

To prevent influenza! - Digital Collections - National Library of Medicine (nih.gov)

One notable example of the first wave's reach is its impact on military camps and the subsequent transmission to civilian populations.

In Camp Funston, the close proximity of soldiers and the constant movement of troops created an ideal environment for the virus to spread rapidly.

Soldiers from infected camps carried the virus to other military installations and, eventually, overseas battlefields. This movement facilitated a global spread that was difficult to contain.


The second wave strikes

The second wave started in the second half of August 1918 and presumably spread by ships from Brest, where it had probably arrived with American troops or French recruits for naval training, to Boston and Freetown, Sierra Leone.

Approximately 30 miles west of Boston, at Camp Devens (later renamed Fort Devens) and the Boston Navy Yard, other U.S. military installations and troops being sent to Europe were soon affected.

Over the course of the following two months, it spread throughout all of North America with the aid of military movements before moving on to Central and South America. Ships also carried it to Brazil and the Caribbean.

The Ottoman Empire first noticed instances in a few soldiers in July 1918.

A graph showing the percentage of people dying in US cities from the 1918 flu pandemic.

Public Domain

Emergency hospital during influenza epidemic, Camp Funston, Kansas. Emergency hospital during influenza epidemic, Description: Beds with patients in an emergency hospital in Camp Funston, Kansas, in the midst of the influenza epidemic. The flu struck while America was at war and was transported across the Atlantic on troop ships. Date: circa 1918.

National Museum of Health and Medicine

The pandemic began in Freetown and continued to spread throughout West Africa along the coast, rivers, and colonial railways as well as from railheads to farther-flung communities.

In September, it arrived in South Africa on ships carrying South African Native Labour Corps members who had just returned from France.

In November, it reached Ethiopia after spreading from there throughout southern Africa and beyond the Zambezi. New York City experienced its first influenza-related fatality on September 15.

A severe outbreak of the illness spread among those who had attended the Philadelphia Liberty Loans Parade, which was conducted in Philadelphia, Pennsylvania, on September 28, 1918, to support government bonds for the First World War, and led to 12,000 deaths.

Seattle policemen wearing cloth face masks handed out by the American Red Cross during the Spanish flu pandemic, December 1918.

The Influenza Epidemic of 1918 (archives.gov)

The second wave originated in Europe and swept through Russia in a southwest-northeast diagonal front, reaching Iran (where it spread through the holy city of Mashhad), and then spreading throughout Asia after the Russian Civil War and the Trans-Siberian railway, reaching India in September, China, and Japan in October.

Lima and Nairobi experienced outbreaks in conjunction with the 11 November 1918 Armistice celebrations, but by December the wave had mostly passed.

The second wave caused a lot more deaths than the first. The initial wave had resembled a conventional flu epidemic; the sick and old were most at risk, while younger, healthier individuals quickly recovered. The pandemic's peak fatality rate occurred in the month of October 1918.

A bar chart showing the relative number of deaths in US cities from the flu pandemic. 

Public Domain

Extract of letter from nurse to her friend at the Haskell Indian Nations University, Kansas, 17th October 1918. Bureau of Indian Affairs.

In this letter, a volunteer nurse assigned to various military bases, writes to friend about her experiences. Her initial reaction to death is a window into a personal experience, rather than an official report: "the first one [officer] that died sure unnerved me-I had to go to the nurses' quarters and cry it out."

volunteer-nurse-letter.pdf (archives.gov)

Between September and December 1918, 292,000 deaths were reported in the United States, compared to 26,000 deaths during the same time period in 1915.

More than 40,000 deaths from influenza and acute respiratory illnesses were documented in the Netherlands. In Bombay, which has a population of 1.1 million, 15,000 people have died. An estimated 12.5–20 million people died from the 1918 flu epidemic in India alone in the final quarter of that year.

Children wearing masks during the Spanish Flu pandemic in 1918, many of which continued to attend school during the outbreak.

Canmore Museum


Third Wave of 1919

After a marine quarantine was lifted in Australia in January 1919, the third wave of the flu soon moved to Europe and the United States, where it persisted through the spring and into June 1919, killing between 12,000 and 20,000 people.

In comparison to other nations at the time, Australia's death rate of 2.7 per 1000 people was among the lowest. Nevertheless, up to 40% of the population was infected, and certain Aboriginal communities saw a mortality rate of 50%.

An pneumonia porch at the U. S. Army Camp Hospital in Aix-les-Bains, France, during the Spanish Flu epidemic of 1918-19. Most flu deaths were of healthy young adults, who died from bacterial pneumonia, a secondary infection caused by the influenza.

Everett Collection Art - Pixels

The third wave killed hundreds of thousands of people worldwide, mainly in Spain, Serbia, Mexico, and Great Britain. Although it wasn't as bad as the second wave, it was still a lot deadlier than the first wave.

A few American cities, including Los Angeles, New York City, Memphis, Nashville, San Francisco, and St. Louis, experienced localised epidemics. During the first half of 1919, there were tens of thousands of deaths in America.

Walter Reed Hospital, Washington, D.C., during the great Influenza Pandemic of 1918 - 1919, also known as the "Spanish Flu". Patients are set up in rows of beds on an open gallery, seperated by hung sheets. A nurse wears a cloth mask over her nose and mouth.

Harris & Ewing photographers - Photo by Harris & Ewing via Library of Congress website


1920: Further outbreaks

Throughout the spring and summer, there were a spate of isolated or solitary instances of flu being reported across the United States.

Even though there had been an increase in isolated cases since September, Chicago began to see one of the first significant flu outbreaks in the middle of January.

Days after Chicago's rapid increase in cases, it was clear that the flu was spreading there even more quickly than it had in winter 1919, though there were fewer fatalities.

The number of new cases in the city surpassed the peak of the 1919 wave within a week. New York City started to experience a dramatic rise of cases around the same time, and other cities throughout the nation quickly followed.

Poster advising what precaution to take to prevent spreading catching and spreading Spanish Flu, 1920.

Broadside : 12421 (theadkx.org)

At a free community clinic, patients wait for a doctor’s attention. Palestine, 1920.

JDC during the Time of the Spanish Flu (1918–1920) | JDC Archives

In cities like Chicago, Memphis, and New York City, certain pandemic restrictions—including the closure of schools and theatres and staggered business hours to reduce congestion—were reinstated in the hope they would help restrict the spread of the flu.

The fourth outbreak in the United States peaked in early February before dissipating as quickly as it had risen.

Data at the time showed that the outbreak caused one-third as many deaths as the events of 1918–1919. Between December 1919 and April 1920, New York City alone reported 6,374 deaths, about twice as many as the initial wave in spring 1918.

Other US cities were particularly heavily struck, with death rates exceeding those of the entire year 1918. These cities included Detroit, Milwaukee, Kansas City, Minneapolis, and St. Louis.

Early in 1920, when the pandemic reached its height in the Territory of Hawaii, 1,489 people there died from flu-related causes, compared to 615 in 1918 and 796 in 1919.

Similarly, Nenana, Alaska, missed the worst of the epidemic for the first two years, but by May 1920, the town had been overrun by an outbreak.

According to reports, the majority of the town's residents contracted the disease within the first two weeks of the month; 10% of the population is thought to have perished.

A Philadelphia streetcar is shown during the pandemic adorned with the 'Spit spreads death' sign, reminding people of the dangers of infection.

Shawshots/Alamy

American Red Cross volunteers at an emergency medical station at Washington. 

Royston Leonard – Mediadrumworld.com

https://www.dailymail.co.uk/news/article-5487803/Spanish-flu-centenary-marked-new-colourised-photos.html

...the 1920 pandemic vanished in a matter of weeks...

"Coughs and Sneezes Spread Diseases - As Dangerous as Poison Gas Shells". U.S. Public Health ad on dangers of Spanish Flu epidemic during the First World War.

A fourth outbreak also occurred in a number of locations in the winter and spring of 1920, including Switzerland, Scandinavia, Mexico, and some South American islands.

In contrast to the peak of 92 deaths in December 1918, Poland saw a devastating outbreak over the winter months.

However, the 1920 pandemic vanished in a matter of weeks, whereas the 1918-1919 wave had evolved during the entire second half of 1918.

The origins of the deadly virus are unclear and it is unknown exactly how many people died but it killing anywhere between 20 and 70 million across the space of two years. Pictured is  a typist wearing a mask while she works in New York City during the epidemic.

Royston Leonard – Mediadrumworld.com

https://www.dailymail.co.uk/news/article-5487803/Spanish-flu-centenary-marked-new-colourised-photos.html

...the pandemic virus had developed into a far less dangerous strain...

Western Europe, in contrast, experienced a "benign" outbreak, with the age distribution of fatalities beginning to resemble that of a seasonal flu.

Between January and April 1920, five European nations—Spain, Denmark, Finland, Germany, and Switzerland—recorded a late high. Early 1920 saw a late wave in Peru, and late 1919 to early 1920 saw one in Japan, with the last cases occurring in March.

By 1920, the pandemic virus had developed into a far less dangerous strain that only caused seasonal flu going forward. Deaths had reached pre-pandemic levels by 1921.

A group of people standing outside are shown wearing masks during the pandemic. One woman wears a sign saying, 'wear a mask or go to jail.'

Niday Picture Library/Alamy


Effect

This pandemic featured extremely high mortality rates for young adults, unlike other influenza epidemics, which disproportionately kill the young and the old with a higher survival rate in between.

The high fatality rate has numerous explanations from scientists, including a six-year climate anomaly that affected disease vector migration and increased the possibility of disease dissemination through bodies of water.

Comparison of the different waves of Spanish Flu across the globe.

Lessons from the 1918-1919 Spanish Flu Pandemic in Africa – Africa Center for Strategic Studies

Although the viral infection appeared to be no more aggressive than earlier influenza strains, the virus was particularly deadly because it sparked a cytokine storm, decimating young people' stronger immune systems.

Malnutrition, overcrowding in hospitals and medical camps, and inadequate hygiene, all made worse by the war, encouraged bacterial superinfection, which led to the majority of victims passing away after a generally protracted time on their deathbeds.


Treatment

Doctors would rely on a haphazard collection of drugs with varying degrees of effectiveness, such as aspirin, quinine, arsenics, digitalis, strychnine, epsom salts, castor oil, and iodine, since there were no antiviral drugs to treat the virus and no antibiotics to treat the secondary bacterial infections.

Traditional medical practices like bloodletting, ayurveda, and kampo were also used as treatments.


Impact on the First World War

Having such a devastating disease running amok across Europe while the First World War was occurring would have inevitably impacted on the various warring sides to some degree.

  • An increase in soldiers unable to fight due to them catching the flu.
  • Tired and weakened troops being more susceptible to the disease in the first place.
  • The increased strain on medical units to cope with an influx of non-battlefield patients.
  • Poor sanitation and living conditions.
  • Wandering refugees acting as carriers for the disease and they moved from area to area seeking shelter.
  • An absence of effective precautions or preventative measures.

All would have had an impact.

Report on staffing crisis at military depot in Philadelphia, October 8, 1918. Office of the Quartermaster General. The flu was highly contagious and spread rapidly, as documented in a military report notifying the Office Quartermaster General in Washington D.C., of a staffing crisis. The report notes 11 officers and 1,489 employees "absent today," with the situation not improving.


Effect on the economy

The Spanish Flu pandemic of 1918-1919 had profound and immediate effects on national and global economies.

As the deadly influenza outbreak claimed an estimated 50 million lives worldwide, it severely disrupted economic activities and exacerbated the social and economic turmoil already caused by the First World War.

In the immediate aftermath, significant labour shortages arose due to high mortality rates, which drastically impacted industrial and agricultural production.

The loss of a substantial portion of the working-age population strained economies, leading to decreased productivity and increased financial instability. Governments, already overburdened by war debts, struggled to manage the additional economic downturn, which contributed to widespread unemployment and poverty.

Life goes on: A baseball player wearing a mask during the Flu epidemic of 1918.

George Rinhart/Corbis via Getty Images

Flu notice in the Oct. 9, 1918 edition of the Bloomington Daily Telephone. Restrictions on public gatherings during the Spanish flu severely impacted the economy by shutting down businesses, reducing consumer spending, and causing widespread unemployment, leading to significant financial losses and economic instability across affected regions.

Dan Combs

How Did Monroe County Deal With The Spanish Flu Pandemic Of 1918? | News - Indiana Public Media

Many companies in the leisure and service sectors reported revenue declines as the pandemic forced closures and reduced consumer spending.

Businesses such as theatres, restaurants, and hotels suffered significant financial losses as people avoided public spaces to curb the spread of the virus.

This downturn led to bankruptcies and the collapse of many small businesses, further aggravating the economic crisis.

Conversely, the healthcare sector experienced profit increases.

The pandemic underscored the critical importance of healthcare services, leading to substantial growth in the nursing profession.

Historian Nancy Bristow notes that the pandemic, along with the rise in female college enrolment, played a significant role in the success of women in nursing.

The majority-male medical professionals' failure to control and stop the disease highlighted the effective care provided by majority-female nursing staff, who took pride in their successful patient care efforts.

The Spanish Flu also exposed the inadequacies of public health systems and the lack of international cooperation in addressing global health crises. The failure to effectively manage the pandemic fostered public distrust in governments and institutions, contributing to political instability.

In the long term, the compounded crises from the pandemic and post-war challenges set the stage for the Great Depression in the 1930s, further destabilizing economies and societies. The resultant economic hardships and political instability were crucial factors in the rise of fascist regimes in Europe.

The inability of weakened democracies to effectively address these issues ultimately led to the aggressive expansionism and conflicts that sparked the Second World War. Thus, while not a direct cause, the Spanish Flu pandemic played a significant role in shaping the volatile global environment that contributed to the outbreak of the war.


Aftermath and Global Impact

Eventually, the Spanish Flu began to fade from the public consciousness, overshadowed by the First World War and its aftermath.

As terrible as the flu was, its horror was overshadowed by the four years of death and destruction which dominated the media and remained firmly in the public eye.

When people read the obituaries, they saw the influenza deaths next to the war or postwar dead. The virus may not have had a significant psychological effect or may have appeared to be a continuation of the war's horrors, especially in Europe where the war's toll was great.

The length of the pandemic and the conflict may have also had an impact. Normally, the sickness would only stay in one place for a month before moving on.

But even though it was initially anticipated that the conflict would end quickly, it had already been going on for four years when the epidemic began. This has led some historians to refer to the Spanish flu as the “forgotten pandemic".

The pandemic had profound and far-reaching effects on the global stage, particularly in the 1920s and 1930s, indirectly contributing to the conditions that led to the outbreak of the Second World War.

This deadly influenza outbreak killed an estimated 50 million people worldwide, exacerbating the already severe social and economic disruptions caused by the First World War.

In the immediate aftermath of the pandemic, many countries faced significant labour shortages due to the high mortality rates, impacting industrial and agricultural production.

The loss of a substantial portion of the working-age population strained economies further, leading to decreased productivity and increased financial instability.

Governments, already burdened by war debts, struggled to manage the additional economic downturn, which contributed to widespread unemployment and poverty.

The Spanish Flu pandemic also highlighted the inadequacies of public health systems and the lack of international cooperation in addressing global health crises.

This failure to effectively manage the pandemic fostered public distrust in governments and institutions, contributing to political instability.

As societies grappled with these challenges, extremist political movements found fertile ground for growth. In Germany, for instance, the economic and social turmoil created a breeding ground for radical ideologies, including the rise of the Nazi Party.

Moreover, the Spanish Flu's psychological impact cannot be underestimated. The immense loss of life and the pervasive fear of disease left lasting scars on the collective psyche, fostering a sense of disillusionment and despair. This widespread trauma weakened social cohesion and contributed to the appeal of authoritarian leaders who promised order and stability.

As the world moved into the 1930s, these compounded crises set the stage for the Great Depression, further destabilizing economies and societies.

The resultant economic hardships and political instability were crucial factors in the rise of fascist regimes in Europe.

The inability of weakened democracies to effectively address these issues ultimately led to the aggressive expansionism and conflicts that sparked the Second World War.

Thus, the Spanish Flu pandemic, while not a direct cause, played a significant role in shaping the volatile global environment that led to the war.

This comparison chart aptly demonstrates how lethal Spanish Flu could be compared to other pandemics.

The Spanish flu: The global impact of the largest influenza pandemic in history - Our World in Data


Further reading

The Spanish flu of 1918–1920, with a death toll between 50 and 100 million, was a monumental disaster, overshadowed by the First World War. In "Pale Rider," Laura Spinney traces the pandemic's global impact, highlighting how it reshaped politics, race relations, family structures, and thought across medicine, religion, and the arts. Spinney shows the flu's significance in testing human ingenuity and vulnerability, demonstrating its profound effect on modern history.


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